Patients telling me I'm "the best doctor [they]'ve ever hard" makes me very uncomfortable. For awhile, I joked, privately, that statement on its own was diagnostic of a personality disorder. (There's some validity there; patients with personality disorders, especially borderline, have a tendency to pick out "best" and "worst" doctors, and especially will pick trainees to be the "best" because we're easy to manipulate.) However, last week, one of the most psychologically stable patients I ever had expressed how grateful he was to have me on his team and praised my knowledge and compassion.
On the one hand, I know I'm skilled clinically. On the other, medical school is nothing if not liminal. I can be a great medical student, but that means nothing. A medical student, by itself is not a state of being. Who's ever heard of telling a caterpillar that it's beautiful -- or worse: that it's good at being a caterpillar? Of course, I strive to be a good doctor, but that doesn't parallel with being a good doctor, or at least not completely. When patients tell me I'm the "best," it's scary; I want to respond with all of the things that I don't know, all of the mistakes that I make every day. Most of the time, though, the urge is overwhelming to hide things I don't know, to avoid admitting my weaknesses and above all, not to let anyone see my mistakes. Being a good medical student involves admitting these things; using them as stepping stones, growing through self-examination. I know, but at the same time, I want to be a good DOCTOR, and I worry that my weaknesses aren't acceptable.
I was stressed in the lab -- I'm having trouble writing my first first-author papers; I'm behind, because stress makes me procrastinate, and I'm getting overwhelmed. The more time that passes, the less I want to talk to my PI, because the more I feel that I haven't done enough. One of my coworkers said "well, what did you think? You would cure cancer all by yourself as a med student?" It's true -- I'm a student. I'm supposed to make mistakes and lean on others, but it's hard to remember. I tell myself "perfect is the enemy of good" nearly every day, but we're encouraged so strongly for so long to look good on paper so that we can get into a good college, good med school, good residency, good job. Liminal -- trying to be something else, never settling. I worry that I'll spend the rest of my life constantly focused on the future, rather than trying to optimize the present. I don't have an answer for that.
My mentor told me a story about when he was in training, he received a call about a patient with an eminent medical emergency. His attending was detached and discouraged questions and had left for the night. My mentor was new, and he knew that he couldn't manage the case on his own and he knew that mismanaging the case would result in permanent disability to the patient. He called another attending, who was not on service, in the middle of the night to discuss the case and the patient did well. It takes a lot of courage to do that. It takes being able to admit that you have a lapse of knowledge to a boss. It's clearly the right thing to do -- being a doctor isn't about the doctor; it's about the patient. I adore and respect my mentor...but I'm scared that I don't have the courage; that I'm too concerned about my own self-image that I would be too diffident about getting yelled at for asking a "stupid" question that I'd try to manage it on my own, and I'd never forgive myself if something bad happened. To be totally honest, I'm scared of even writing that in a public forum -- scared that you're all going to judge me for being too self-absorbed for doing the right thing. The only defense I have is that I hope that by knowing this, by thinking about it and by being honest about my barriers, I will prevent myself from actually making the mistake when it's not just a thought experiment.

Writing has never come easily for me. My parents had to be called in to my third grade classroom, because I refused to put words to paper. There are reasons -- as most people who know me can imagine, I need structure, and my hippy school didn't really teach grammar. Even more difficult to me was semantics -- having ideas that were of supreme importance but being unable to grasp how to convey these ideas in words. It's still very much a struggle for me.
I knew, about one year ago, that I needed to go back to blogging. There's good evidence that medical professionals who write in at least a semi-structured manner have a higher level of empathy, decreased depression, and in general, are better at self-criticism and self-improvement. It makes sense -- medicine has the illusion of a solitary pursuit. One of my favorite medical concepts is "causitry" -- using a case to determine principles, especially in ethics. The connotation is that the case is used instead of a rational derivation of principles. The parallel, I think, is key to how physicians view themselves. We think of ourselves as cases, without connection to others moving around us. Some of this is the structure of medical training, which is systematically designed to innure the medical student to illness, suffering of physical and emotional varieties and, ultimately, death. On the one hand, training as part of a team is emphasized more in medicine than anywhere else I have been exposed to; on the other, close friendships among coworkers are rare and self-exclusion from the patients and global culture is an unspoken expectation. Discussing ones own emotions is a social taboo -- although technically encouraged, the "unwritten curriculum" mandates disparaging all such conversations. One's difficulties and mistakes are an even more unforgiveable conversation -- allowed among other healthcare professionals; but there is a stigma to sharing the lack of perfection in medicine as a whole with the lay personnel. I remember the conversation that made me leave Oberlin Hillel -- "you can discuss problems with Israel, but only with Jews." So, there's one excuse not to write. But, in the end, it requires buying in to all of the problems that I see in medicine -- that is the sort of physician that it is easy to be, but not the sort of physician that it is good to be. I struggle every day to be the sort of doctor to share decision making with my patients, to avoid paternalism, not to glorify medicine or exaggerate the science behind my decisions. Being open is a requirement for trust, and ultimately, being open with myself is an obligation that I have both to my self and to my patients.
I still hate writing. I'm a very verbal thinker -- if I can't think of the word for something, or I can't phrase it correctly, I very literally can't think it. At the same time, I'm not a linear thinker -- I will frequently formulate thoughts from the same starting point and go different directions and then return to the starting point and go somewhere else -- trying to mold these thoughts into words that must go marching on in the same direction, leaving the other vetors of thought to the wayside frustrates me. It makes me feel flattened. I feel shallow -- the thoughts that mean so much in my head mean so very little on paper. I write this in a google doc page, reassuring myself that if I hate these words, I need never publish them. (I will because I will force myself -- I know that if I don't, I will only be making it harder for myself to blog next time and I have committed myself to writing.)
I can't remember where I was going with this, other than to commit myself to writing and to explain why it is so damn difficult for me and to commit myself to write on a regular basis.